Management of Care Q 25
A 6-year-old client is admitted to the unit with a hemoglobin of 6g/dL. The physician has written an order to transfuse 2 units of whole blood. When discussing the treatment, the child’s mother tells the nurse that she does not believe in having blood transfusions and that she will not allow her child to have the treatment. What nursing action is most appropriate?
A. Ask the mother to leave while the blood transfusion is in progress
B. Encourage the mother to reconsider
C. Explain the consequences without treatment
D. Notify the physician of the mother’s refusal
Correct Answer: D. Notify the physician of the mother’s refusal
If the client’s mother refuses the blood transfusion, the doctor should be notified. Because the client is a minor, the court might order treatment. Appropriate management of such patients entails understanding of ethical and legal issues involved, providing meticulous medical management, use of prohemostatic agents, essential interventions and techniques to reduce blood loss and hence, reduce the risk of subsequent need for blood transfusion.
Option A: It is inappropriate to ask the mother to leave during blood transfusion, especially as she has not consented to it. Respect for patient’s autonomy and human rights require obtaining informed consent before any medical intervention. This is fundamental to good medical practice. The rejection of blood transfusions causes an ethical dilemma between the patient’s freedom to accept or to reject a medical treatment even unto death (i.e., autonomy), and the physician’s duty to provide optimal treatment.
Option B: It is better to discuss with patients the specifics of blood transfusion refusal, if possible. A mentally competent individual has an absolute moral and legal right to refuse or reject the consent for medical treatment or transfusion except when he has diminished decision-making capacity or a legal intervention mandates treatment.
Option C: It is the physician’s primary responsibility to explain the consequences to the mother and try to encourage her to consent for the procedure. It is important to convince that every attempt will be made to avoid blood, but also convey that a doctor would not allow a child to let die for lack of blood transfusion. In the UK, children under 16 years of age can legally give consent if they can understand the issues involved (Gillick Competence).